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Workplace Bullying in
Nurses

Journal of Health Psychology

Copyright 2001 SAGE Publications
London, Thousand Oaks and New Delhi,
[13591053(200101)6:1]
Vol 6(1) 7384; 015313

LYN QUINE
University of Kent at Canterbury, UK

Abstract
is Reader in Health Psychology at the
Centre for Research in Health Behaviour, Department
of Psychology, University of Kent at Canterbury. Her
research interests include occupational health, stress
moderators and mediators, and the application of
social cognition models to health-related behaviour.
LY N Q U I N E

AC K N OW L E D G E M E N T S :

The author would like to thank all the NHS

staff who participated in this study.

COMPETING INTERESTS:
A D D R E S S.

None declared.

Correspondence should be directed to:

LY N Q U I N E , Centre for Research in Health Behaviour, Department of
Psychology, University of Kent at Canterbury, Canterbury CT2 7NP, UK.
[Tel. +44 1227 823078; Fax +44 1227 827032; email: L.Quine@ukc.ac.uk]

The article reports a study of

workplace bullying in
community nurses in an NHS
trust. The aims were to
determine the prevalence of
bullying, to examine the
association between bullying
and occupational health
outcomes, and to investigate
whether support at work could
moderate the effects of
bullying. Forty-four percent of
nurses reported experiencing
one or more types of bullying in
the previous 12 months,
compared to 35 percent of other
staff. Fifty percent of nurses had
witnessed the bullying of others.
Nurses who had been bullied
reported significantly lower
levels of job satisfaction and
significantly higher levels of
anxiety, depression and
propensity to leave. They were
also more critical of aspects of
the organizational climate of
the trust. Support at work was
able to protect nurses from
some of the damaging effects of
bullying.

Keywords
nurses, stress moderators,
support at work, workplace
bullying
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W O R K P L AC E bullying refers to a process in
which the victim is subjected to a series of systematic stigmatizing attacks from a fellow
worker or workers which encroach on his or her
civil rights. With a few exceptions (e.g. Brodsky,
1976) it was not recognized as an issue of scientific interest until the mid-1980s. Systematic
research began in Scandinavia (Bjorkqvist,
Osterman, & Hjelt-Back, 1994; Leymann, 1990;
Leymann & Gustavsson, 1984) and there is now
high public awareness, government-funded
research and established anti-bullying legislation. In the UK, although trades unions have
recognized workplace bullying as an important
issue for about five years, and a number of
reports have described the misery, psychological
distress and physical illness suffered by victims
of bullying (MSF, 1995; NASUWT, 1995, 1996;
UNISON, 1997), it has only recently become a
subject of academic study. In June 1997, for
example, the Journal of Community and Applied
Social Psychology devoted a special issue to the
subject of Bullying in Adult Life which contained several articles on workplace bullying
(Adams, 1997; Crawford, 1997; Rayner, 1997;
Rayner & Hoel, 1997).
In the school-based literature, bullying is
defined as a subset of aggressive behaviours
involving three criteria: it is intentional harmdoing or aggressive behaviour; it involves an
imbalance of power between the victim and the
bully; and it is carried out repeatedly and over
time (Olweus, 1999). Three main types of bullying are identified: direct physical, verbal and
indirect. Research into workplace bullying presents the researcher with significantly more difficulties, for there is no clear consensus on what
constitutes adult bullying, whether it refers to a
range of possible behaviours or can be expressed
in a single definition. Though physical bullying is
rarely reported (Einarsen, Raknes, &
Matthiesen, 1994), the workplace presents
opportunities for a wider range of intimidating
behaviours. Rayner and Hoel (1997, p. 183)
suggest that five categories of bullying behaviour
are to be found. These are: threat to professional
status (e.g. belittling opinion, public professional
humiliation, accusation of lack of effort); threat
to personal standing (e.g. gossiping about you,
name-calling, insults, teasing); isolation (e.g.
preventing access to opportunities such as leave
or training, physical or social isolation, with-

74

holding of information); overwork (e.g. undue

pressure to produce work, impossible deadlines,
unnecessary disruptions); and destabilization
(e.g. failure to give credit when due, meaningless
tasks, removal of responsibility, shifting of goalposts, repeated reminders of error, setting up to
fail).
Definitions of workplace bullying generally
share three common elements. First, bullying is
defined in terms of its impact on the recipient.
Bullying exists when an individual is subjected
to a range of intimidating behaviours which
make him or her feel bullied or harassed. Thus it
is subject to variations in personal perceptions,
which present further methodological problems
for the researcher. Second, most definitions
suggest that there must be a negative effect on the
victim (Lockhart, 1997; Lyons, Tivey, & Ball,
1995; Randall, 1997; Rayner & Hoel, 1997). See,
for example, Lyons, Tivey and Balls definition:
persistent, offensive, abusive, intimidating,
malicious or insulting behaviour, abuse of
power or unfair penal sanctions, which makes
the recipient feel upset, threatened, humiliated
or vulnerable, which undermines their selfconfidence and which may cause them to suffer
stress. (Lyons et al., 1995, p. 3) (emphasis
added)
Third, the bullying behaviour must be persistent. In Sweden, for example, an incidence of
about one occurrence a week for the past six
months is adopted (Vartia, 1996). As in school
bullying, some definitions include an intention
on the part of the bully to cause harm (ACAS,
1999), while others, influenced by case law
definitions in the related areas of racial and
sexual harassment, deliberately exclude it (see
Leymann, 1996; Lyons et al., 1995).
The literature reflects three main approaches
to workplace bullying. The first has been qualitative and individualistic, identifying a role for the
individual either in terms of vulnerability to bullying or a propensity to bully (Brodsky, 1976;
Crawford, 1997; Field, 1996; Lockhart, 1997;
Randall, 1997). Primarily dependent on anecdotal evidence and illustrated by case histories,
these writers elucidate the processes by which
people become bullies or victims and the dynamics of bullyvictim relationships. The second
approach has been descriptive and epidemiological and is usually based on self-report

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elicited by structured interviews or postal

questionnaires (Bjorkqvist et al., 1994; Einarsen
& Skogstad, 1996; Leymann & Thallgren, 1989;
Rayner, 1997). These studies document the
prevalence of workplace bullying, age and sex
differences, the types of bullying experienced,
who is told, what action is taken, and so on. The
third approach, epitomized by the Scandinavian
research, is influenced by theories and constructs
in organizational psychology and has focused on
the interaction between the individual and the
organization and the way aspects of the organizational structure and climate of the workplace
may affect both the interpretation of behaviour as
bullying and its acceptance (Einarsen et al., 1994;
Einarsen & Skogstad, 1996; Vartia, 1996; Zapf,
Knorz, & Kulla, 1996). Relationships have been
demonstrated between high rates of workplace
bullying and male-dominated organizations,
leadership style, low job control, role conflict,
lack of participation in decision-making processes, and lack of support from senior staff.
These aspects of the organizational climate are
seen as encouraging the development of a bullying culture.
It has been suggested in the literature on occupational stress (Payne, 1979) that having a supportive work environment can act as a coping
strategy, helping to moderate the effects of work
stressors such as bullying and protecting the
individual from the harmful effects of stress.
This is consistent with the idea that some of the
functions of social support are related to
appraisal (information relevant to self-evaluation) and emotional concern (House, 1981).
Our study, which reports on bullying among
nurses in an NHS community trust, investigated
whether support at work could perform this
moderating role. The objectives of the study
were: (1) to assess the prevalence of workplace
bullying in nurses and to examine the differences in rates between them and other staff; (2)
to examine the relationships between bullying
and occupational health; and (3) to investigate
whether job control and support at work can
protect staff from the adverse effects of bullying.

The study
In 1996 a community NHS trust in the south-east
of England commissioned an examination of the
prevalence of workplace bullying as part of a

larger survey of working life. The trust provides

a range of mental health, learning disability,
primary care, and child health services comprising residential care facilities, multidisciplinary
community and day service teams, health promotion, health visiting, school and community
nursing services, occupational therapy, physiotherapy, speech and language therapy, and child
and family psychiatry services. Results for all
staff are reported in the British Medical Journal
(Quine, 1999). This study concentrates on the
396 qualified nurses in the trust, and examines
differences in the prevalence of bullying
between them and other staff.

Participants and procedure

A questionnaire entitled Working Life Survey
was sent out to all 1580 trust employees,
together with a covering letter explaining the
purpose of the research and a prepaid envelope.
The questionnaire was anonymous to encourage
participation, but we asked participants to post
back a prepaid postcard which they had signed
at the same time as they returned their questionnaires. This enabled us to send reminders to
staff who had not returned questionnaires.
Reminders were sent after three weeks, followed by a second questionnaire after a further
three weeks, and then a final reminder. After
this the data were entered onto computer and
analysed using SPSS for Unix.

The questionnaire
The questionnaire contained four sections.
Section 1 collected profile information about the
participants job, qualifications, professional
group, hours worked, and supervisory responsibilities. Section 2 contained measures of the
occupational health outcomes: job satisfaction
(Quinn & Staines, 1979), propensity to leave
(Cammann, Fichmann, Jenkins, & Klesh, 1979)
and anxiety and depression (Zigmond & Snaith,
1983). A scale measuring support at work
adapted from Payne (1979) was also included.
The Job Satisfaction Scale uses five items to tap
a workers general affective reaction to the job
(Quinn & Staines, 1979). Propensity to leave
was measured by the subscale of the Michigan
Organizational Assessment Questionnaire
(Cammann et al., 1979). It provides a three-item
index of employees intention to leave their job.
The Hospital Anxiety and Depression Scale is a
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14-item measure, seven items of which measure

anxiety and seven of which measure depression
(Zigmond & Snaith, 1983). Cut-off points are
provided to give the best separation between
non-cases (07), doubtful cases (810) and cases
(11+) of clinical anxiety and depression. The
scale can be used as a continuous score to
measure severity. Care was taken when it was
produced to separate out the concept of
emotional and somatic illness, so the scores are
reported not to be affected by the presence of
bodily illness.
Support at work was measured by a scale
adapted from Paynes (1979) work, in which the
author defines support as the degree to which
the work environment makes available
resources (physical, intellectual, technical,
financial and social) relevant to the demands
made upon the system/person/group) (Payne,
1979, p. 86). Staff were asked to rate on a 5-point
scale a number of resources in the work environment, including feedback and support from colleagues and managers, access to community
resources, level of workplace morale, positive
working practices, work environment, etc. All
the scales have been used widely in the literature
and are reported to have satisfactory reliability
and validity.
The third section of the questionnaire contained questions about the staffs perceptions of
the organizational climate of the trust and their
experience of workplace bullying, and examined
the consequences of bullying. We tried to avoid
some of the methodological problems inherent
in some previous research by enquiring about
the experience of bullying behaviours rather
than bullying itself, which is more likely to be
subject to variations in personal perceptions.
Twenty types of bullying behaviour were culled
from the literature (Adams, 1992; Bassman,
1992), representing each of the categories provided in Rayner and Hoels (1997) work. Staff
were asked to indicate whether they had been
persistently subjected to any of these behaviours
in the workplace in the last 12 months. Since the
commissioning trust was concerned to establish
the prevalence of each type of bullying behaviour since trust status had been granted, we used
a time period of 12 months and a simple yes/no
response so that we could report the results as
percentages. Section 4 of the questionnaire
asked for sociodemographic informationage,
76

gender, educational level, etcand contained

questions concerning smoking, drinking and
exercise habits.

Results
A total of 1100 completed questionnaires was
returned, representing a response rate of 70
percent. Seventy-three percent (n = 778) of participants held professional qualifications: 36
percent of the sample (n = 396) were qualified
nurses from a range of disciplines, for example
registered general nurses, registered mental
health nurses, registered learning disabilities
nurses and health visitors; 12 percent (n = 132)
had secretarial or administrative qualifications;
10 percent (n = 111) had qualifications in the
therapies (occupational, speech and language,
chiropody, physiotherapy); 5 percent (n = 49)
had medical degrees; 1 percent (n = 11) had
qualifications in clinical psychology; and 9
percent (n = 101) had a range of qualifications in
other areas such as social work, residential care
or health promotion. Twenty-seven percent of
staff (n = 300) were unqualified. These staff comprised unqualified residential care staff, porters
and catering, cleaning and maintenance staff.
Table 1 shows the profile of the participants,
including the distribution by age, gender and
hours worked. Note that participant numbers do
not always add up to 1100 because questions
Table 1. Profile of participants
%

Occupational group
Nurses
Therapists
Administrative staff
Doctors
Clinical psychologists
Other professionals
Unqualified staff
Total

36
10
12
5
1
9
27
100

396
111
132
49
11
101
300
1100

Gender
Male
Female
Total

16
84
100

176
915
1091

Hours
Full time
Part time
Total

51
49
100

560
537
1097

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were occasionally omitted by error. Checks

made with the personnel department indicated
that the sample accurately reflected the profile
of the trust in terms of age, gender and occupational groups, and there was no indication that
non-responders differed from responders in any
significant way.

Scale reliability
Scales were constructed of all the main measures
and their reliability was investigated using
Cronbachs alpha (see Table 2). Satisfactory
alphas were found for all scales.

Prevalence of bullying
Qualified nurses were more likely to have been
subjected to bullying than other staff in general.
Overall, significantly more nurses (44 percent, n
= 174) reported experiencing one or more types
of bullying in the previous 12 months, compared
with other staff (35 percent, n = 247, 2 = 8.4,
d.f. = 1, p < .01). Nurses also reported experiencing significantly more types of bullying than
other staff (nurses M = 2.2, SD = 3.8; other staff
M = 1.5, SD = 2.9, t = 3.5, p < .001). Table 3 shows
the percentage of nurses and other staff experiencing each category and type of bullying behaviour. Thirty-three percent of nurses had
experienced destabilizing behaviours, compared
to 23 percent of other staff. Twenty-seven
percent had experienced behaviours designed to
isolate, compared with 21 percent of other staff.
Twenty-two percent had experienced threats to
personal standing, compared with 18 percent of
other staff. Nineteen percent of nurses had
experienced threats to professional status, compared to 16 percent of other staff and 19 percent
had experienced pressure to overwork, compared to 13 percent of other staff. There was no
statistically significant difference between
nurses and other staff in the category Threat to
professional status, though one item, Persistent

attempts to belittle and undermine your work,

showed a significant difference. Nor was there a
statistical difference in the category Threat to
personal standing between nurses and other
staff, though three individual items showed statistically significant differences. However, for
the categories Isolation, Overwork, and
Destabilization there were significant differences between nurses and other staff. A higher
proportion of nurses experienced bullying from
these categories than other staff did.
Nurses were also more likely than other staff
to have witnessed the bullying of others. Fifty
percent of nurses (n = 198) reported witnessing
other people being bullied in the previous 12
months, compared to 36 percent (n = 250) of
other staff (2 = 13.4, d.f. = 1, p < .001).

Characteristics of the victims of

bullying
Among nurses there were no differences by age
or gender in reports of bullying. However,
nurses who worked full time were more likely to
be bullied than those who worked part time (65
percent, (n = 113) as against 35 percent (n = 61),
2 = 9.1, d.f. = 1, p < .01). Of nurses who had
experienced bullying, 69 percent (n = 63) had
tried to take action about the bullying when it
occurred. Strategies included ignoring the bully
(48 percent, n = 34), talking to friends and colleagues (86 percent, n = 61), reporting it to personnel or to a line manager (59 percent, n = 41),
making a formal complaint (6 percent, n = 4), or
confronting the bully themselves (37 percent, n
= 26), but only 22 percent (n = 15) were satisfied
with the outcome. Only 7 percent (n = 5) had
used the staff stress counselling service, which
was comparatively new.
Twenty-six percent (n = 45) of nurses who had
experienced bullying reported that their health
had been affected, and 18 percent (n = 26) were
unsure. Eight percent (n = 13) had taken time off

Table 2. Mean, standard deviation and reliability of scales

Job satisfaction
Propensity to leave
Anxiety
Depression
Support at work
Bullying scale

Items

SD

5
3
7
7
17
20

0.84
0.71
0.85
0.81
0.91
0.81

12.5
7.6
6.8
3.9
54.7
3.1

2.7
2.8
4.0
3.3
12.7
3.3

1064
1083
1079
1078
1093
1093
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Table 3. Differences between nurses and other staff for each type and category of bullying
Nurses

Other staff

n = 396

n = 704

Threat to professional
1. Persistent attempts to belittle and undermine your work
2. Persistent unjustified criticism and monitoring of your work
3. Persistent attempts to humiliate you in front of colleagues
4. Intimidatory use of discipline/competence procedures

19
15
11
10
7

(76)
(57)
(41)
(37)
(26)

16
10
10
8
4

(109)
(67)
(68)
(53)
(31)

2.5
6.0
0.2
1.2
2.5

NS
**
NS
NS
NS

Threat to personal standing

5. Undermining your personal integrity
6. Destructive innuendo and sarcasm
7. Verbal and non-verbal threats
8. Making inappropriate jokes about you
9. Persistent teasing
10. Physical violence
11. Violence to property

22
14
14
7
6
4
2
1

(88)
(53)
(54)
(26)
(25)
(15)
(7)
(4)

18
9
10
5
3
2
2
2

(129)
(61)
(69)
(37)
(24)
(17)
(11)
(12)

2.4
6.1
3.8
0.8
5.1
1.7
0.1
0.8

NS
**
*
NS
*
NS
NS
NS

Isolation
12. Withholding necessary information from you
13. Freezing out/ignoring/excluding
14. Unreasonable refusal of applications for leave, training
or promotion

27
20
15
12

(107)
(78)
(58)
(47)

21
14
12
5

(148)
(100)
(85)
(31)

5.1
5.8
1.5
21.7

*
**
NS
***

Overwork
15. Undue pressure to produce work
16. Setting of impossible deadlines

19
17
10

(74)
(66)
(39)

13
11
7

(92)
(73)
(50)

6.2
9.2
2.5

**
**
NS

Destabilization
17. Shifting goalposts without telling you
18. Constant undervaluing of your efforts
19. Persistent attempts to demoralize you
20. Removal of areas of responsibility without consultation

33
27
14
13
10

(132)
(105)
(56)
(49)
(40)

23
14
10
9
6

(162)
(99)
(70)
(65)
(44)

13.8
26.1
4.5
2.7
5.4

***
***
*
NS
*

status

Denotes experience of one or more behaviours in each category

NS: not significant, * p < .05, ** p < .01, *** p < .001

work because of bullying. A wide range of symptoms of malaise were described, including feeling
unwanted or devalued (71 percent, n = 70), thinking about leaving the job (76 percent, n = 60),
feeling miserable and depressed (87 percent, n =
69), feeling as if they did not want to go to work
(82 percent, n = 65), feeling easily upset (73
percent, n = 58), having difficulty sleeping (70
percent, n = 55), feeling worthless (60 percent, n
= 47), feeling constantly keyed up and jittery (54
percent, n = 43), and feeling anxious most of the
time (51 percent, n = 40). Forty-three percent (n
= 20) of smokers who had experienced bullying
reported an increase in their smoking in the
previous year, and 43 percent (n = 39) of drinkers
reported an increase in their drinking habits.
Eighty-three percent (n = 143) of nurses who had
been bullied reported an increase in stress levels.
78

Characteristics of the bully

Those nurses who reported bullying were asked
to describe a recent incident (in the last three
months) and a number of questions were asked
about it. Twenty-five percent of nurses (n = 96)
described a recent incident. They reported that
when an incident occurred, the bully was most
likely to be a senior manager or line manager (59
percent, n = 77), though in 38 percent of cases (n
= 36) it was someone of the same level of seniority, and in 3 percent of cases (n = 3) it was
someone less senior than the victim. In 26
percent of cases the bully was male, in 66 percent
of cases female, and in 8 percent of cases the
victim was bullied by a person of each gender.
The bully was frequently older than the victim
(44 percent of cases, n = 39), though in 31
percent of cases (n = 27) both parties were of

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similar age, and in 25 percent of cases (n = 22)

the bully was younger than the victim.

Relationship between bullying

and perceptions of the
organizational climate
Nurses who reported one or more types of
bullying were more likely than other nurses to
be critical of aspects of the organizational
climate of the trust. They reported higher workloads (M = 3.2, SD = 1.0 as against M = 2.8, SD
= 0.9, t [1, 383] = 4.3, p < .001), greater role ambiguity (M = 2.5, SD = 1.2 as against M = 1.9, SD =
0.9, t [1, 387] = 6.4, p < .001), less participation in
decision making (M = 2.9, SD = 1.2 as against M
= 1.9, SD = 0.9, t [1, 389] = 7.8, p < .001) and
lower job control (M = 16.5, SD = 4.3 as against
M = 19.5, SD = 2.5, t [1, 377] = 8.2, p < .001) than
did other nurses.

Relationships with occupational

health outcomes
Relationships between bullying and occupational health outcomes were examined by ttest or chi-squared test where appropriate.
Nurses who had experienced one or more types
of bullying in the last year reported significantly
lower levels of job satisfaction at the time of
response than nurses who were not bullied (M =
10.1, SD = 2.8 as against M = 11.9, SD = 2.2, t [1,
386] = 7.2, p < .001). Additionally they had
higher scores on the Propensity to Leave Scale,
showing that they were more likely to contemplate leaving than nurses who were not bullied
(M = 8.5, SD = 2.9 as against M = 7.3, SD = 2.6,
t [1, 396] = 4.3, p < .001). They were significantly
more likely to suffer clinical levels of anxiety (34
percent, n = 59 as against 11 percent, n = 24, d.f.
= 1, 2 = 31.4, p < .001) and depression (8
percent, n = 14 as against 1 percent, n = 3, d.f. =
1, 2 = 10.6, p < .001) as measured by the cut-off
point of the Hospital Anxiety and Depression
Scale. They took significantly more days off

work for sickness absence than nurses who were

not bullied (M = 18.0, SD = 50.1 as against M =
5.3, SD = 16.4, t [1, 378] = 3.4, p < .001).

Correlations between
occupational health outcomes
and categories of bullying
Correlations between the five categories of
bullying and occupational health outcomes conducted for nurses only are presented in Table 4.
Each of the categories of bullying was significantly positively correlated with anxiety, depression and propensity to leave, and negatively
correlated with job satisfaction. The categories
of bullying that proved to have the highest
correlations with occupational health outcomes
for nurses were pressure to overwork and destabilization.

Support at work as a buffer

against bullying
As we suggested earlier, it has been hypothesized that having a supportive work environment may moderate the effects of work stressors
such as bullying, buffering the individual from
their harmful consequences. According to
Baron and Kenny (1986), a moderator is a variable that partitions a focal independent variable
into subgroups that establish its domains of
maximal effectiveness in regard to a given
dependent variable. The moderator effect is
typically shown as an interaction term in analysis of variance, in this case high/low bullying by
good/poor support.
To test whether support at work could moderate the effects of bullying for nurses, four twoway analyses of variance were conducted. The
dependent variables were job satisfaction,
propensity to leave, anxiety and depression. The
independent variables were scores on the
support at work scale, which was split at the
median to give two groups, nurses with poor
support (49 percent, n = 193) and nurses with

Table 4. Correlations between occupational health outcomes and categories of bullying

Threat to professional status
Threat to personal standing
Overwork
Isolation
Destabilization

Job satisfaction

Anxiety

Depression

Propensity to leave

0.27***
0.20***
0.30***
0.26***
0.39***

0.25***
0.26***
0.41***
0.23***
0.31***

0.21***
0.25***
0.37***
0.25***
0.33***

0.21***
0.11*
0.17***
0.21***
0.26***

* p < .05, *** p < .001

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good support (51 percent, n = 200), and scores

on the bullying variable, which was divided into
reported bullying (44 percent, n = 174) and no
reported bullying (56 percent, n = 222). Figure 1
and Table 5 show that there were main effects of
bullying and support on all outcome variables
and interaction (modifying) effects for three out
of four outcome variables.

Discussion
Almost one in two nurses reported experiencing
one or more types of bullying, compared with
one in three other staff in the trust. This compares with about one in five found in a recent
UNISON survey of union members (UNISON,
1997) and one in three in a Royal College of
Nursing Survey (Alderman, 1997), though such
comparisons should be treated with caution
because of differences in definition and timeline.
A higher proportion of nurses than other staff
reported 13 of the 20 bullying behaviours. The
behaviours reported most frequently were shifting the goalposts, withholding necessary information, undue pressure to produce work,
freezing out, ignoring or excluding, and persistent attempts to belittle or undermine the
persons work. Nurses were also more likely to
have witnessed the bullying of others.
A quarter of nurses who had been bullied
reported that their health had been affected, and
8 percent had taken time off work because of it.
A wide range of illness symptoms was reported,
from feeling miserable and depressed, and
feeling unwanted or devalued, to having difficulty sleeping. Nearly 70 percent of those bullied
had tried to take action to stop the bullying, but
only 22 percent were satisfied with the outcome.
The most likely bully was a manager who was
older than the victim. Nurses who had been
bullied had less positive perceptions of the
organizational climate than other nurses. They
were more likely to report having higher work-

loads, greater role ambiguity, less participation

in decision-making processes and lower job
control than other nurses.
Nurses who had experienced bullying
reported lower levels of job satisfaction and
were more likely to report wanting to leave.
They were more likely to be clinically anxious
and depressed. These findings are consistent
with those of research from Norway and
Finland. In the Norwegian study, Einarsen and
Raknes (1991) found that employees who had
been bullied were especially affected by depression, while in the Finnish study (Bjorkqvist et al.,
1994) bullied employees showed significantly
more symptoms of anxiety and depression. In a
cross-sectional study, the causal definition of
variables cannot be properly determined. Three
possible explanations may be advanced to
account for the associations between bullying
and negative outcomes. The first is that being
bullied does indeed lead to psychological illhealth, reduced job satisfaction and a desire to
leave the job. The second is that being depressed
or anxious may place a person at risk of bullying
by people who single out the weaker ones to victimize. Anxiety or depression may also weaken
an individuals ability to cope with stressors such
as bullying. The third explanation is that certain
staff may be more likely to perceive themselves
as (or report being) bullied than others and to
report lower levels of job satisfaction and higher
levels of depression, anxiety and propensity to
leave. These might be people who are more pessimistic in outlook or have a tendency to experience negative emotional states.
Recently attention has turned to the role of
negative affectivity in understanding relations
between self-reports of stressors and strains
(Watson & Pennebaker, 1989; Watson, Pennebaker, & Folger, 1987). Watson and Clark
(1984), for example, have argued that a number
of commonly used instruments such as the
Taylor Manifest Anxiety Scale (Taylor, 1953)

Table 5. Results of two-way analysis of variance

Outcome

Main effect of bullying

Main effect of support

Interaction effect

Job satisfaction
Anxiety
Depression
Propensity to leave

F (1, 389) = 22.3 ***

F (1, 384) = 25.0 ***
F (1, 383) = 25.3 ***
F (1, 389) = 8.1 **

F (1, 389) = 50.8 ***

F (1, 384) = 18.6 ***
F (1, 383) = 31.1 ***
F (1, 389) = 24.0 ***

F (1, 389) = 4.1 **

F (1, 384) = 0.1 NS
F (1, 383) = 4.9 *
F (1, 389) = 4.3 *

NS: not significant, * p < .05, ** p < .01, *** p < .001
80

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Figure 1. Results of the analysis of variance.

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and the Beck Depression Inventory (Beck,

Ward, Mendelson, Mock, & Erbaugh, 1961)
purporting to measure trait anxiety and depression can be considered as alternative measures
of a more global trait, which they named negative affectivity. The authors define negative
affectivity as a stable and pervasive individual
difference characterized by a tendency to
experience aversive emotional states. They
conclude that high negative affectivity individuals are more likely to report distress, discomfort, and dissatisfaction over time and
regardless of the situation, even in the absence
of any overt or objective sources of stress
(Watson & Clark, 1984, p. 483). High levels of
negative affectivity are associated with a type
of cognitive bias through which people
approach or interpret their life experiences.
This cognitive style may influence how people
experience and evaluate their job.
A number of investigators have shown that
negative affectivity does inflate correlations
between stressors and work-related variables.
Inflated correlations have been found for job
satisfaction (Levin & Stokes, 1989), somatic
complaints and symptoms of depression (Burke,
Brief, & George, 1993, though see also Chen and
Spector, 1991, who found that negative affectivity accounts for a large proportion of shared
variance between stressors and physical symptoms, but not for much of the variance shared by
stressors and affective strains such as job satisfaction and feelings of stress). Longitudinal data
and a conceptually developed scale of negative
affectivity such as that produced by Stokes and
Levin (1990) are required to try to disentangle
these effects, for the issue is complex. However,
to suggest that victims of bullying are simply
those who view the world through gloomier
spectacles introduces a fundamental problem,
since it denies the existence of bullying and precludes any discussion of the health consequences
that bullying may have for the victim. In our
study, 50 percent of nurses had witnessed the
bullying of others, including many who did not
report being bullied themselves. This suggests
that bullying is not simply in the eye of the
beholder. The role of negative affectivity may be
partially to inflate the correlations between
bullying and adverse health outcomes rather
than to explain them. This issue requires further
research in which the effects of negative affec82

tivity are partialled out. In addition, bullying

seems to occur significantly more frequently
among some occupational groups, which
together with the findings on organizational
climate suggests a role for organizational
factors. Much of the Scandinavian research
addresses this topic (Einarsen & Skogstad, 1996;
Vartia, 1996; Zapf et al., 1996), but as yet it has
not been investigated in the UK.
The results of the two-way analysis of variance support the hypothesis that a supportive
work environment is able to act as a moderator,
protecting individuals from some of the harmful
effects of bullying. Nurses who reported being
bullied but had good support at work had significantly lower scores on the propensity to leave
and depression scales and higher scores for job
satisfaction than those who reported being
bullied but had poor support. Cohen and Hoberman (1983) suggest that support may function as
a buffer against stress by meeting coping
requirements related to the appraisal and selfesteem that are elicited when individuals experience stressful events. Other factors such as high
levels of job control and personal dispositions
such as hardiness, optimism or self-efficacy may
also be able to protect people against bullying.
These deserve research attention.
Bullying at work is acknowledged as a workplace risk by the Health and Safety Executive in
their guide Stress at Work (Health and Safety
Executive, 1995). The guide reminds employers
that there is a duty under the Management of
Health and Safety at Work Regulations
(MHSW, 1992) to assess the nature and scale of
risks to health in the workplace and base their
control measures on it. The guide advises that
employers should have effective systems for
dealing with interpersonal conflict, bullying and
racial and sexual harassment, including agreed
grievance procedures and proper investigation
of complaints. The provision and enactment of
policies and procedures against bullying will
benefit employees and employers alike: reduced
stress results in better health, reduced sickness
absence, increased performance and output,
better relationships with clients and colleagues,
lower staff absence and turnover and less likelihood of litigation from workers who believe
their health has been damaged. Travers and
Cooper (1993), for example, have estimated that
between 30 and 55 percent of all work-related

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stress is caused by workplace bullying and that

40 million working days a year are lost because
of it.
The results of this study indicate that in
combination with developing anti-bullying policies and formal and informal grievance procedures, taking steps to provide a positive work
environment with appropriate attention to staff
support structures may be an effective way of
protecting peoples health and welfare in the
workplace.

References
ACAS. (1999). Bullying and harassment at work: A
guide for employees. London: ACAS.
Adams, A. (1992). Bullying at work: How to confront
and overcome it. London: Virago.
Adams, A. (1997). Bullying at work. Journal of Community and Applied Social Psychology, 7, 177180.
Alderman, C. (1997). Bullying in the workplace.
Nursing Standard, 11(35), 2226.
Baron, R. M., & Kenny, D. A. (1986). The moderator
mediator variable distinction in social psychological
research: conceptual, strategic, and statistical
considerations. Journal of Personality and Social
Psychology, 51, 11731182.
Bassman, E. (1992). Abuse in the workplace. New
York: Quorum.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., &
Erbaugh, J. (1961). An inventory for measuring
depression. Archives of General Psychiatry, 4, 461571.
Bjorkqvist, K., Osterman, K., & Hjelt-Back, M. (1994).
Aggression among university employees. Aggressive Behaviour, 20, 173184.
Brodsky, C. M. (1976). The harassed worker. Toronto:
Lexington.
Burke, M. J., Brief, A. P., & George, J. M. (1993). The
role of negative affect in understanding relations
between self-reports of stressors and strains: A
comment on the applied psychology literature.
Journal of Applied Psychology, 78(3), 402412.
Cammann, C., Fichmann, M., Jenkins, D., & Klesh, J.
(1979). The Michigan Organizational Assessment
Questionnaire (Unpublished manuscript). Ann
Arbor, MI: University of Michigan.
Chen, P. Y., & Spector, P. E. (1991). Negative affectivity as the underlying cause of correlations between
stressors and strains. Journal of Applied Psychology,
76, 398407.
Cohen, S., & Hoberman, H. M. (1983). Positive events
and social support as buffers of life change stress.
Journal of Applied Social Psychology, 13(2), 99125.
Crawford, I. (1997). Bullying at work: a psychoanalytic
perspective. Journal of Community and Applied
Social Psychology, 7, 219225.

Einarsen, S., & Raknes, B. I. (1991). Mobbing in worklife:

A study of the prevalence and health effects of mobbing
in Norwegian workplaces. Bergen: Forksningscenter
for arbeidsmilj (FAHS), University of Bergen.
Einarsen, S., Raknes, B. I., & Matthiesen, S. B. (1994).
Bullying and its relationship to work and environment quality: An exploratory study. European Work
and Organizational Psychologist, 4, 381401.
Einarsen, S., & Skogstad, A. (1996). Bullying at work:
Epidemiological findings in public and private
organizations. European Journal of Work and
Organizational Psychology, 5(2), 185201.
Field, T. (1996). Bully in sight: How to predict, resist,
challenge and combat workplace bullying. Wantage:
Success Unlimited.
Health and Safety Executive. (1995). Stress at work: A
guide for employees. London: HMSO.
House, J. S. (1981). Work stress and social support.
Reading, MA: Addison-Wesley.
Levin, I., & Stokes, J. P. (1989). Dispositional
approach to job satisfaction: Role of negative affectivity. Journal of Applied Psychology, 74, 752758.
Leymann, H. (1990). Mobbing and psychological
terror at workplaces. Violence and Victims, 5(2),
119126.
Leymann, H. (1996). The content and development of
mobbing at work. European Journal of Work and
Organizational Psychology, 5(2), 165184.
Leymann, H., & Gustavsson, B. (1984). Psychological
violence at workplaces: Two exploratory studies.
Stockholm: Arbetarskyddsstyrelsen.
Leymann, H., & Thallgren, U. (1989). An investigation
into the frequency of bullying in SSAB, with a new
questionnaire. Arbete, Manniska, Mjilo, 1, 312.
Lockhart, K. (1997). Experience from a staff support
service. Journal of Community and Applied Social
Psychology, 7, 193198.
Lyons, R., Tivey, H., & Ball, C. (1995). Bullying at
work: How to tackle it. A guide for MSF representatives and members. London: MSF.
MHSW (1992). Management of Health and Safety at
Work Regulations 1992 Approved Code of Practice
L21. London: Health and Safety Executive Books.
MSF. (1995). How big is the problem of bullying at
work? Report of a survey of MSF workplace representatives on their experiences and impressions of
bullying at work. London: MSF.
NASUWT. (1995). Workplace bullying: Report of
NASUWT survey of members 1995. Birmingham:
NASUWT.
NASUWT. (1996). No place to hide: Confronting
workplace bullies. Birmingham: NASUWT.
Olweus, D. (1999). Bullying in Sweden. In P. K. Smith,
Y. Morita, J. Junger-Tas, D. Olweus, R. Catalano, &
P. Slee (Eds.), The nature of school bullying (p. 11).
London: Routledge.
Payne, R. (1979). Demands, supports, constraints and
83

06 Quine (jk/d)

16/11/00 10:00 am

Page 84

JOURNAL OF HEALTH PSYCHOLOGY 6(1)

psychological health. In C. Mackay, & T. Cox (Eds.),
Response to stress: Occupational aspects, 85105.
London: IPC Business Press.
Quine, L. (1999). Workplace bullying in NHS community trust: Staff questionnaire survey. British
Medical Journal, 318, 228232.
Quinn, R. P., & Staines, G. L. (1979). The 1977 Quality
of Employment Survey. Ann Arbor, MI: Institute
for Social Research, University of Michigan.
Randall, P. (1997). Adult bullying: Perpetrators and
victims. London: Routledge.
Rayner, C. (1997). The incidence of workplace bullying. Journal of Community and Applied Social Psychology, 7, 199208.
Rayner, C., & Hoel, H. (1997). A summary review of
literature relating to workplace bullying. Journal of
Community and Applied Social Psychology, 7,
181191.
Stokes, J. P., & Levin, I. M. (1990). The development
and validation of a measure of negative affectivity.
Journal of Social Behavior and Personality, 5(2),
173186.
Taylor, J. A. (1953). A personality scale of manifest
anxiety. Journal of Abnormal Social Psychology, 48,
285290.
Travers, C., & Cooper, C. (1993). Occupational stress
among UK teachers. Work and Stress, 7, 203219.

84

UNISON. (1997). Bullying at work: Bullying survey

report . London: UNISON.
Vartia, M. (1996). The sources of bullying: Psychological work environment and organizational
climate. European Journal of Work and Organizational Psychology, 5(2), 203214.
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional
states. Psychological Bulletin, 96, 465490.
Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress and distress: exploring the central role
of negative affectivity. Psychological Review, 96,
234254.
Watson, D., Pennebaker, J. W., & Folger, R. (1987).
Beyond negative affectivity: Measuring stress and
satisfaction in the workplace. In J. M. Ivancevitch
& D. C. Ganster (Eds.), Job stress: From theory to
suggestion (pp. 141157). New York: Haworth
Press.
Zapf, D., Knorz, C., & Kulla, M. (1996). On the
relationship between mobbing factors and job
content, social work environment and health outcomes. European Journal of Work and Organizational Psychology, 5(2), 215237.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital
Anxiety and Depression Scale. Acta Psychiatrica
Scandinavica, 67, 361370.